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Dental Charges and Services Not Covered Under the Plan

The following dental services or supplies are not covered under the MILA National Health Plan.

  • Services or supplies for treatment before the Plan coverage begins for that person;
  • Services not performed by a dentist, except for those services of a licensed dental hygienist which are supervised and billed by a dentist and which are for:
    • Scaling and polishing of teeth; or
    • Fluoride treatments.
  • Cosmetic surgery or supplies including plastic surgery, reconstructive surgery, cosmetic surgery, personalization or characterization of dentures or other services or supplies which improve or alter or enhance appearance, augmentation and vestibuloplasty, and other substances to protect, clean, whiten, bleach or alter the appearance of teeth; whether or not for psychological or emotional reasons; except to the extent coverage is specifically provided in the list of covered dental services here. Facings on molar crowns and pontics will always be considered cosmetic. However, any cosmetic surgery or supply will be covered if:
    • It otherwise would be a covered expense; and
    • It is required for reconstructive surgery which is incidental to or follows surgery which results from a trauma, an infection or other disease of the involved part; or
    • It is required for reconstructive surgery because of a congenital disease or anomaly of a covered child which has resulted in a functional defect.
  • Replacement of lost, missing or stolen crown, bridge or denture;
  • Services or supplies which are covered by any Workers’ Compensation laws or occupational disease laws;
  • Services or supplies which are covered by any employers’ liability laws;
  • Services or supplies which any employer is required by law to furnish in whole or in part;
  • Services or supplies which are received through a medical department or similar facility which is maintained by the covered person’s employer;
  • Services or supplies which are received by a covered person for which no charge would have been made in the absence of this Plan’s coverage;
  • Services or supplies for which a covered person is not required to pay;
  • Services or supplies which are deemed experimental in terms of generally-accepted dental standards;
  • Services or supplies which are received as a result of dental disease, defect or injury due to an act of war, or war-like act in time of peace which occurs while the Plan’s coverage is in effect for the covered person;
  • Adjustment of a denture or bridgework which is made within six months after installation by the same dentist who installed it;
  • Dental implants and the removal of implants;
  • Dental braces, mouthguards and other devices to protect, replace or reposition teeth except for space maintainers for children and children’s orthodontic appliances;
  • General anesthesia and intravenous sedation, unless specifically covered and only when done in connection with another necessary covered service or supply;
  • Any duplicate appliance or prosthetic device;
  • Use of material or of home health aides to prevent decay, such as toothpaste or fluoride gels other than the topical application of fluoride;
  • Instruction for oral care such as oral hygiene, plaque control or diet;
  • Dentures, crowns, inlays, onlays, bridges or other appliances or services used for the purpose of splinting or to alter the vertical dimension, to restore occlusion or correcting attrition or erosion except as specifically provided in the list of covered dental services here;
  • First installation of a denture or fixed bridge and any inlay or crown that serves as an abutment to replace congenitally missing teeth or to replace teeth all of which were lost while the person was not covered by this Plan;
  • Temporary or provisional restorations;
  • Temporary or provisional appliances;
  • Services or supplies to the extent that benefits are otherwise provided under this Plan, under any other MILA Plan or under any other plan to which the Employer (or an affiliate) contributes or sponsors;
  • Fixed and removable appliances for correction of harmful habits;
  • Appliances or treatment for bruxism (grinding teeth), including but not limited to occlusal guards and night guards, except as specifically provided in the list of covered services here;
  • Charges for broken appointments;
  • Charges by the Dentist for completing dental forms or submitting dental claims;
  • Sterilization supplies;
  • Services or supplies furnished by a family member;
  • Treatment of any jaw joint disorder and any treatments to alter bite or the alignment or operation of the jaw, including temporomandibular joint disorders (TMJ), orthognathic surgery and treatment of malocclusion or devices to alter bite or alignment, except as specifically provided in the list of covered services here; and
  • Orthodontia for persons other than children.